Apparatus for disintegrating concretions in body cavities of living organisms by means of an ultrasonic probe

ABSTRACT

An ultrasonic probe for disintegrating concretions e.g. urinary calculus, in body cavities comprises a probe tube, ultrasonically vibrated in a longitudinal direction, having at one end a tubular impact element loosely coupled to it in the direction of vibration. The impact element is provided on its free end with a cutting edge, preferably formed by a plurality of teeth. The disintegrated concretions are continuously evacuated through the tubular impact element and the tubular probe.

United States Patent [191 Pohlman et a1.

APPARATUS'FOR DISINTEGRATING CONCRETIONS IN BODY CAVITIES OF LIVINGORGANISMS BY MEANS OF AN ULTRASONIC PROBE Reimar Pohlman; ManfredCichos, both of Aachen, Germany Assignee: Reimar Pohlman, Aachen,Germany Filed: Apr. 16, 1973 Appl. No.: 351,140

inventors:

Foreign Application Priority Data Apr. 22, 1972 Germany 2219790 U.S. Cl128/305, 128/276, 128/328, 128/24 A Int. Cl A6lb 17/32 Field of Search128/303, 24 A, 305, 276, 128/328, 319

Primary Examiner-Lawrence W. Trapp I [5 7 1 ABSTRACT An ultrasonic probefor disintegrating concretions e.g. urinary calculus, in body cavitiescomprises a probe tube, ultrasonically vibrated in a longitudinaldirection, having at one end a tubular impact element loosely coupled toit in the direction of vibration. The impact element is provided on itsfree end with a cutting edge, preferably formed by a plurality of teeth.The disintegrated concretions are continuously evacuated through thetubular impact element and the tubular probe.

12 Claims, 7 Drawing Figures PATENTED JUL 1 s 1924 APPARATUS FORDISINTEGRATING CONCRETIONS IN BODY CAVITIES OF LIVING ORGANISMS BY MEANSOF AN ULTRASONIC PROBE BACKGROUND OF THE INVENTION This inventionrelates to an apparatus for disintegrating concretions in body cavitiesof living organisms by means of an ultrasonic probe.

It is known to treat hard and brittle materials by means of ultrasonicvibrations. in this case a tool profiled in any desired manner andexcited to longitudinal vibrations is lowered into the material to betreated with interposition of a boron carbide suspension. By this meansperforations, dies etc. can be made in hard and brittle materials.

The present invention pursues a totally different purpose, namely toproduce brittle fractures in hard and brittle bodies in order to destroythe said bodies, e.g. urinary calculus. By this means it is desired todestroy or disintegrate a urinary calculus presentin the human bladderto such an extent that the debris can be exhausted or removed from thebladder through natural channels without difficulty.

Now when it is attempted to obtain brittle fractures by means ofultrasonic vibrations, although e.g. in the case of disintegration ofurinary calculus, relatively soft types of calculus such as phosphatecalculus, can be reduced fairly rapidly by ultrasonic vibrations; on theother hand harder types, such as urate Calculus, oxalate calculus, canonly be disintegrated into small debris extraordinarily slowly, or evennot at all.

Known apparatusses operate on the principle that a concretion present ina body cavity is touched by a rodshaped ultrasonic probe introducedthrough natural channels, whereupon by pressing the concretion againstthe wall of the body cavity the ultrasonic vibrations are transmitted tothe concretion and the latter is thereby destroyed. Because the pressureforces required in this case are relatively powerful. there is a risk,more particularly with small smooth concretions, that the sonic probemay slip off, so that the wall of the body cavity may become damaged.Moreover, if such small smooth concretions are also extremely hard, thenin the majority of cases they cannot be disintegrated at all by thisprocedure, because they move away at the very first contact by theultrasonic probe.

Furthermore, the known apparatus suffers from an other disadvantage.When it is actually possible to disintegrate a concretion, then in everycase initially the disintegrated debris of the calculus and the stonedust suspended in the liquor are left behind in the body cavity. Thisgives rise to on the one hand to a visual obstruction for the opticalexamination instrument (endoscope) introduced with the ultrasonic probe,and on the other hand to the necessity of removing the stone residuesfrom the body cavity by a separate operation, which furthermore can nolonger be performed under visual control. For this purpose theultrasonic probe must be removed out of the body cavity and anotherinstrument, for example a so-called suction syringe, must be used.

SUMMARY OF THE lNVENTlON The invention aims at providing an apparatusfor disintegrating concretions in body cavities by means of anultrasonic probe, whereby the disadvantages of the apparatusses of thistype hitherto known are obviated.

To this end, the present invention consists in an apparatus fordisintegrating concretions in body cavities in living organisms,comprising a tubular probe ultrasonically vibrated longitudinally and atubular impact element loosely coupled in the direction of vibration toone end of said tubular probe whereby the ultrasonic vibrationstransmitted to the impact element are transformed into shock forces.

Due to the interposition of the impact element, the shattering effect ofthe ultrasonic vibrations is increased by orders of magnitude. Theimpact element should be as hard and highly elastic as possible, and isarranged loosely between the ultrasonic probe and the body to bedisintegrated. This unyielding element is capable of collecting impulseshocks statistically from the ultrasonic vibrations acting periodicallyupon it, and to transmit them in very brief and highly intensive impactshocks to the body to be disintegrated. lt has been found that thesecollected" highly intensive impulse shocks can achieve orders ofmagnitude and can initiate percussive forces which exceed many times thepressure peaks transmitted periodically by the ultrasonic probe tube andare capable of causing the desired brittle fractures. Even the hardesttypes or urinary calculus (urate and oxalate calculus) can be destroyedby this means.

By virtue of the tubular construction of the impact element and of theultrasonic probe tube, it becomes possible to exhaust the fragments ofcalculus continuously by an exhauster device as they are detached duringthe actual disintegration operation, so that it is unnecessary to useadditionally a further apparatus to exhaust them after thedisintegration of the concretion. Furthermore, the continuous exhaustionof the fragments of calculus and of the stone dust produce the furtheradvantage that no obstruction of vision for the optical observationinstrument (endoscope) occurs. And

lastly, the exhaustion of the fragments of calculus also sucks thecalculus itself towards the front end of the tubular impact element, sothat on the one hand it centres itself automatically upon the impactelement, so that the latter is largely prevented from slipping off,while at the same time a certain'contact pressure is generated wherebythe contact force against the wall of the body cavity which was hithertonecessary is substantially reduced. Since furthermore the shocks of theimpact element only have a destructive effect when they strike hardbodies, no injury to the soft wall of the body cavity occurs even if thelatter is accidentally touched.

The characteristic property of the impact element to transform theultrasonic vibrations transmitted to it into powerful shock forces oflow frequency produces a number of advantages:

Only a much weaker contact pressure is required to achieve the desiredeffect, compared to the apparatusses hitherto known. Furthermore, it ispossible to destroy with ultrasonic vibrations of hitherto customaryamplitude and power, concretions which would have withstood destructionwithout the interposition of an impact element.

Preferably, the end of the tubular impact element remote from saidcoupling is constructed as a cutting edge which may advantageously beconstituted by a plurality of teeth. The efficacity of the destructionof concretions is increased by these measures.

It is furthermore advantageous to make the teeth of undercut trapezoidalconstruction so that their cutting surfaces are larger than their rootsurfaces, since in this manner the disintegrated culculus material caneasily be discharged by the exhaustion operation. Furthermore, if theteeth are arranged mutually joggled or twisted, so that their cuttingedges project partly beyond the outer circumference of the tubesupporting them and into the interior space of the said tube, then onthe one hand the risk of the impact element seizing in the calculus isreduced, while on the other hand it has the effect that the diameter ofthe hole generated is greater than the diameter of the impact elementcarrying the teeth, and the stone fragments are smaller than theinternal diameter of the impact element and of the tubular ultrasonicprobe. In this way a clogging of the entire instrument by thedisintegrated stones is reliably obviated. Furthermore the advantage isobtained that with this mode of construction the tubular impact elementtends to dance" in the peripheral direction, so that it repeatedlystrikes fresh points of the concretion to be destroyed.

The impact element is preferably guided loosely with slight radial andaxial play on the end of the ultrasonic probe tube. In this case theimpact element can be prevented from falling out by various measureswhich later be more fully explained.

It has further been found particularly advantageous to construct theultrasonic vibrator tube and/or the impact element coupled to it, at themutual contact surfaces, so that a linear or punctiform contact occurs,since in the case of an areal contact the recoil of the element isconsiderably impaired by the adherence layer of interlying liquid. Theelastic shock conditions are also appreciably improved.

BRIEF DESCRIPTION OF THE DRAWINGS In order that the invention may bemore readily understood. reference is made to the accompanying drawingswhich illustrate diagrammatically and by way of example severalembodiments thereof, and in which:

FIG. 1 shows the front end of an ultrasonic probe with tubular impactelement. partly in section;

FIG. 2 shows the side elevation of the cutting edge of the impactelement with trapezoidal teeth;

FIG. 3 shows the plan of the cutting edge with twisted teeth and of theimpact-element (in a section along the line III-III of FIG. 1);

FIG. 4 shows an impact element with rounded and corrugated impactsurface;

FIG. 5 shows an impact element with conical impact surface and capsleeve;

FIG. 6 shows an impact element with helicoidal spring retaining means;and

FIG. 7 shows an impact element with tubular retaining means.

DESCRIPTION OF THE PREFERRED EMBODIMENTS Referring to FIG. 1, anultrasonic probe comprises a tube 1 and an impact element 2. The tube 1is oscillated longitudinally by an ultrasonic generator indicated by thedouble arrow 27. The impact element 2 is likewise of tubularconstruction and carries at one end teeth 7 as a cutting edge. Due tothe longitudinal oscillations of the tube 1, impulses are transmitted tothe impact element 2, which are intensified in the above describedmanner into very powerful impulse peaks, because the "impact element 2is supported loosely in the radial and axial direction in or on thetube 1. The loose mounting ofthe impact element is ensured in that asufficient tolerance in the radial direction is provided by shank guidemeans 4 in the end of the tube 1, whilst axial movement of the impactelement 2 is limited on the one hand by an impact surface 3 on theelement 2 and on the other hand by retaining pins 5, 5 which engage inslots 6, 6' in the impact element 2, so that the impact element 2 isprevented from dropping out of the tube 1. The teeth 7 of the impactelement 2 constructed as a tube section are arranged joggled, so thatonly those fragments of the concretion treated which have a smallerdiameter than that of the tube can penetrate into the tube 1, so thateasy evacuation of the fragments in the direction of the arrow 27through the tube 1 is possible.

As FIG. 2 shows, the teeth 7 are advantageously of trapezoidalconstruction with their wide side acting as chisels, so that they do notjam in the case ofa less brittle concretions, but can automatically borethemselves free. The discharge of the material to the exhaustor deviceis furthermore greatly facilitated by this means.

FIG. 3 illustrates the impact element 2 viewed axially in plan andpartly in section along the line Ill-Ill of FIG. 1. The teeth 7 arearranged twisted so that a line connecting the outer edges of the teethhas a greater diameter than the outside diameter D of the impact element2, whilst a line connecting the inner edges of the teeth has a smallerdiameter than the inside diameter d of the impact element 2.

FIG. 4 shows a construction of the impact surfaces at the front end ofthe ultrasonic probe tube 8 and on the impact element 9. The end of thetube 8 is substantially conically countersunk at its end face 9a,whereby an automatic centering of the impact element 9 is created. Theimpact element 9 is rounded at its contact surface 10, so that its restsnot upon a plane surface but only upon an encircling line. If desired,the rounded support surfaces 10 may be corrugated as at 100, so thatonly support points remain.

FIG. 5 shows the mode of supporting an impact element 1] on anultrasonic probe tube 12 by a cap sleeve 13. In this case, for thepurpose of automatic centering, both the impact surfaces l4, 15 areconically tapered.

FIG. 6 illustrates an embodiment in which an impact element 16 isloosely supported on an ultrasonic probe tube 17 by means of a helicalspring 18. The spring is dimensioned so that in the rest position asmall gap 19 remains between the impact element I6 and the tube 17,which is closed only when the impact element 16 is pressed against thetube 17, so that energy is transmitted only then. By virtue of thisconstruction, during idle running, the excited but inoperativeultrasonic vibrator does not touch the impact element at all and avoidsunnecessary wear of the impact surfaces and stressing of the supportmeans.

FIG. 7 shows means for supporting an impact element 20 on an ultrasonicprobe tube 21 by means of a soft resilient sleeve 22 which can beadjusted so that again a small gap 23 remains between impact surfaces24, 25. The impact surfaces may be rounded and/or conically tapered.

We claim:

1. An apparatus for disintegrating concretions in body cavities inliving organisms, comprising a tubular probe adapted to beultrasonically vibrated longitudinally and a tubular impact elementloosely coupled in the direction of vibration to one end of said tubularprobe whereby the ultrasonic vibrations transmitted to the impactelement are transformed into shock forces.

2. An apparatus as claimed in claim I, wherein the end of the tubularimpact element remote from said coupling is constructed as a cuttingedge.

3. An apparatus as claimed in claim 2, wherein the cutting edge isconstituted by a plurality of teeth.

4. An apparatus as claimed in claim 3, wherein the teeth are of anundercut. trapezoidal construction so that their cutting surfaces arelarger than their root surfaces.

5. An apparatus as claimed in claim 3, wherein the teeth are arrangedmutually joggled or twisted so that a line connecting the outer edges ofthe teeth has a greater diameter than the external diameter of theimpact element and a line connecting the inner edges of the teeth has asmaller diameter than the internal diameter of the impact element.

6. An apparatus as claimed in any of the claim 2, wherein the impactelement is guided loosely with slight radial and axial play on the endof the tubular probe.

7. An apparatus as claimed in claim 6, wherein the impact element isprevented from dropping out of the tubular probe by retaining pins whichengage in slots provided in the impact element.

8. An apparatus as claimed in claim 6, wherein the impact element isloosely supported by a cap sleeve secured to the tubular probe.

9. An apparatus as claimed in claim 6, wherein the impact element issupported by a helicoidal spring contacting the tubular probe and theimpact element.

10. An apparatus as claimed in claim 6, wherein the impact element issupported by a resilient tube contacting the tubular probe and theimpact element.

11. An apparatus as claimed in claim 6, wherein those parts of theultrasonic probe tube and of the impact element where the two componentsare in mutual contact during their axial movement caused by theultrasonic vibrations are of tapered construction of at least one ofsaid parts.

12. An apparatus as claimed in claim 1, wherein the ultrasonic probetube is adapted to be connected to an exhaustor device.

1. An apparatus for disintegrating concretions in body cavities inliving organisms, comprising a tubular probe adapted to beultrasonically vibrated longitudinally and a tubular impact elementloosely coupled in the direction of vibration to one end of said tubularprobe whereby the ultrasonic vibrations transmitted to the impactelement are transformed into shock forces.
 2. An apparatus as claimed inclaim 1, wherein the end of the tubular impact element remote from saidcoupling is constructed as a cutting edge.
 3. An apparatus as claimed inclaim 2, wherein the cutting edge is constituted by a plurality ofteeth.
 4. An apparatus as claimed in claim 3, wherein the teeth are ofan undercut, trapezoidal construction so that their cutting surfaces arelarger than their root surfaces.
 5. An apparatus as claimed in claim 3,wherein the teeth are arranged mutually joggled or twisted so that aline connecting the outer edges of the teeth has a greater diameter thanthe external diameter of the impact element and a line connecting theinner edges of the teeth has a smaller diameter than the internaldiameter of the impact element.
 6. An apparatus as claimed in any of theclaim 2, wherein the impact element is guided loosely with slight radialand axial play on the end of the tubular probe.
 7. An apparatus asclaimed in claim 6, wherein the impact element is prevented fromdropping out of the tubular probe by retaining pins which engage inslots provided in the impact element.
 8. An apparatus as claimed inclaim 6, wherein the impact element is loosely supported by a cap sleevesecured to the tubular probe.
 9. An apparatus as claimed in claim 6,wherein the impact element is supported by a helicoidal springcontacTing the tubular probe and the impact element.
 10. An apparatus asclaimed in claim 6, wherein the impact element is supported by aresilient tube contacting the tubular probe and the impact element. 11.An apparatus as claimed in claim 6, wherein those parts of theultrasonic probe tube and of the impact element where the two componentsare in mutual contact during their axial movement caused by theultrasonic vibrations are of rounded tapered construction of at leastone of said parts.
 12. An apparatus as claimed in claim 1, wherein theultrasonic probe tube is adapted to be connected to an exhaustor device.